Republic of the Philippines

LAGUNA STATE POLYTECHNIC UNIVERSITY

Main Campus
Santa Cruz, Laguna
COLLEGE OF COMPUTER STUDIES
APPLICATION FOR GENERAL OFFICE PRACTICUM
November 09, 2011
PROF. RONALDO S. MAGLAPUZ
Dean, College of Computer Studies
Laguna State Polytechnic University
Main Campus, Santa Cruz, Laguna
SIR:
I have the honor to apply for the General Office Practicum of the Diploma in Computer
Secretarial Program this Second Semester, Academic Year 2011-2012.
Attached is the Waiver/Agreement Form, Resume with 2x2 Picture, Photocopy of Latest
Registration Form, and Photocopy of Community Tax Certificate (cedula) of my parent.
Very truly yours,
________________________________
Signature over Printed Name of Student
____________________________________________________________________________
APPLICATION FORM for the GENERAL OFFICE PRACTICUM
1. _________________________________________________ Gender: _____________
(Surname)

2.
3.
4.
5.
6.
7.
8.

9.

(First Name)

(Middle Name)

Course:________________________________________ Year & Section: __________

Date of Birth: ____________________________________ Age: __________________
City Address: ___________________________________________________________
Provincial Address: ______________________________________________________
__________________________________________________________
Landline Phone Number: _______________ Mobile Phone Number: ______________
Name of Parents/Guardian: ________________________ Relationship:____________
Complete Mailing Address of Parents/Guardian:_______________________________
_____________________________________________________________________
Contact Number/s: ______________________________________________________
Office/ Company Reference:_______________________________________________

Company Name
First Choice: ________________________________
Second Choice:______________________________
Third Choice:________________________________

Address
___________________________
___________________________
___________________________

_________________________________
Signature over Printed Name of Student

Republic of the Philippines

LAGUNA STATE POLYTECHNIC UNIVERSITY
Main Campus
Santa Cruz, Laguna
COLLEGE OF COMPUTER STUDIES

WAIVER / AGREEMENT FORM

November 09, 2011

Hon. NESTOR M. DE VERA, Ph.D.
University President
Laguna State Polytechnic University
Santa Cruz, Laguna
SIR:
In consideration for permitting Mr./Ms. ______________________________________,
(Name of Student)
an Diploma in Computer Secretarial student to undergo General Office Practicum this second
semester of Academic Year 2011-2012, I, _________________________________________,
(Name of Parent/Guardian)
voluntarily renounce and waive any claim, personal or pecuniary, against Laguna State
Polytechnic University and the Practicum Company/ Office for the injury that the trainee may
sustain, loss or suffer during her Practicum.
In my own free will, I am willing to abide to the policies and regulations of the program of
this institution and that any untoward incidents will not be the liability of the Laguna State
Polytechnic University, Practicum Company/ Office and the instructor/s engaged in the said
course.
I acknowledge that I have read this waiver and is aware of the legal consequences of
signing this document.

_____________________________
Signature Over Printed Name
of Parent/Guardian

__________________________
Signature Over Printed Name
of Student

Date Signed: ____________________________

Date Signed: _____________________

Community Tax Cert. No.: __________________

Student No.: ______________________

Date of Issue: ____________________________

Course/ Yr.& Sec: _________________

Place of Issue: ___________________________

Contact No.: _____________________

Home Address: ___________________________

Home Address: ____________________

________________________________________

________________________________